Prevalence of vertebral artery origin stenosis and occlusion in outpatient extracranial ultrasonography

Abstract

Background and purpose—Most data on the prevalence of vertebral artery origin (VAo) disease is
derived from hospital-based studies of patients with posterior circulation strokes and TIA. The prevalence
of VAo disease in patients without posterior circulation symptoms or asymptomatic patients is poorly characterized. Our objective was to examine the prevalence of VAo stenosis and occlusion in consecutive
patients, presenting for extracranial ultrasonography to an outpatient laboratory.
Methods—We retrospectively identified 2490 consecutive extracranial duplex studies performed in an
ambulatory neurovascular ultrasound laboratory. All studies were reviewed for the presence of >50% VAo
stenosis, defined as a PSV > 114 cm/s, and VA occlusion. We also reviewed the prevalence of >50% carotid stenosis, defined as a PSV > 120 cm/s, in the same population, to draw comparisons with VAo stenosis
prevalence.
Results—We identified right VAo stenosis in 52/1955 (2.7%) and occlusion in 74/1955 (3.9%) and leftsided VAo stenosis in 45/1973 (2.5%) and occlusion in 64/1973 (3.6%). The prevalence of having any
(either right or left) VAo stenosis or occlusion was 8.2% and 1.4% had bilateral VAo stenosis or occlusion.
Right carotid stenosis and occlusion was found in 236/2399 (9.8%) and 53/2399 (2.2%) and left carotid
stenosis and occlusion in 236/2397 (9.8%) and 45/2397 (1.9%), respectively. Any carotid disease, either
right or left, was present in 18.9% and 4.7% had bilateral carotid disease.
Conclusion—Although less prevalent than cervical carotid disease, we found that approximately 8% of
patients who presented to an ambulatory ultrasound laboratory had >50% VAo disease.